• 대한두개안면성형외과학회지
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• 제22권1호
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• pp.45-51
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• 2021

Background: Mandibular deficiency leading to facial asymmetry causes cosmetic deformity as well as psychological stigma for the patient. Correction of these mandibular asymmetries is a major challenge. The study investigates the efficacy of bidirectional mandible distraction for the treatment of mandibular deficiency. Methods: This prospective study included six individuals aged between 17 and 24.4 years. Five patients had hemifacial microsomia and one had unilateral temporomandibular joint ankyloses. All patients underwent mandibular distraction osteogenesis. Postoperative skeletal changes in affected mandible, and changes in occlusal plane and oral commissure cant were evaluated using three-dimensional reconstruction. Patient satisfaction and understanding of the procedure were assessed through three questionnaires administered during pre-distraction, distraction and post-distraction phases. Results: In pre-distraction phase, aesthetic appearance seemed to be the primary indication for surgery. In distraction phase, pain while chewing was the primary handicap. In post-distraction phase all patients were satisfied with the aesthetic outcome. The facial deformity was improved through mandibular distraction osteogenesis. On the affected side in all the patients, height and length of the mandible increased. Canting of the occlusal plane and oral commissure was corrected. Conclusion: Bidirectional mandible distraction is an effective treatment for correction of mandible deformities in adult patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권4호
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• pp.297-306
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• 2007

Distraction osteogenesis was pioneered by Ilizarov in the treatment of injured extremities. Its subsequent application to Oral and Maxillofacial Surgery has opened a new chapter in the treatment of facial deformity. Careful monitoring of the period of distraction and consolidation of the callus is important and has been well described. Complications, such as infection, haematoma and premature ossification, are difficult to diagnose and can compromise the outcome after the surgery. Too slow rate of distraction results in premature fusion of cortices and too rapid information of bone 'cyst' within the callus distraction. I experienced 2 patients of congenital unilateral mandibular hypoplasia, so called Hemifacial Microsomia. After distraction surgery, I evaluated callus formation of mandibular distraction with Ultrasound Sonography during distraction and consolidation period. Plain radiography, although it enables accurate measurement of the distraction gap, did not give sufficient detail to allow assessment of early stages of bone formation, But, ultrasound monitoring could enable continuous monitoring of the distraction gap without exposure to ionizing radiation and allow detection of fine detail, which may influence manipulation of the callus.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권4호
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• pp.460-467
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• 2008

Pierre Robin sequence as a symptom triad of micrognathia, glossoptosis, and cleft palate results in upper airway obstruction and feeding problems. If mild, it is often managed in the prone position. When positional treatment fails, however, surgical intervention such as tongue-lip adhesion, tracheostomy, and mandibular distraction osteogenesis is mandatory to relieve airway obstruction. There has been growing interest in the application of distraction osteogenesis for the management of craniofacial abnormalities. The mandibular distraction osteogenesis to newborns may prevent the airway obstruction, decrease the potential tracheostomy, and reduce the likehood of orthognathic surgery after growth. We experienced an infant with Pierre Robin sequence who showed mandibular hypoplasia, glossoptosis, incomplete cleft palate, intermittent cyanos is, depression of the chest, and respiratory difficulty associated with airway obstruction. We treated the airway obstruction by tongue-lip adhesion at 2 weeks of age, and treated the mandibular retrognathism and depression of the chest byusing internal mandibular distraction osteogenesis at 7 month of age. The mandible moved forwardly, the upper airway space was enlarged, and the antero-posterior distance of the mandible was elongated after the mandibular distraction. Mandibular distraction osteogenesis may be a promising technique to avoid the need of tracheostomy and orthognathic surgery, and to correct airway obstruction in infants with congenital craniofacial malformation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권6호
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• pp.516-525
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• 2004

Mandibular symphyseal distraction osteogenesis is an alternative approach for correcting mandibular transverse deficiencies and dental crowding. The traditional approaches for these are extraction of teeth and arch expansion with traditional orthodontic treatment. Also extractions are usually unavoidable in patients with severe crowding. The purpose of this study is to evaluate the effect of mandibular symphyseal distraction osteogenesis by use of tooth-borne expansion appliance. All of 12 patients had been performed distraction osteogenesis. The surgical procedures were accomplished under local anesthesia and intravenous sedation in an ambulatory surgical setting using a routine distraction protocol. The latency period was 5 days or 7 days after symphyseal osteotomies. The rate & rhyth is a intermittent, 0.75mm or 1.0 mm per day and stabilized for 6, 8 weeks after distraction. The time of orthodontic tooth movement after distraction was variable from 2 weeks to 8 weeks (mean 3 weeks). All patients had been evaluated with study casts, plain periapical films, panorama radiograms before & after surgery. Mandibular symphyseal distraction osteogenesis increased mandibular arch width and corrected dental crowding, with paralleling tooth-borne movement, without proclination of the mandibular incisors.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권5호
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• pp.480-488
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• 2008

Orthodontists often treat cases which are difficult to treat with conventional orthodontics. In such cases, it could be treated with surgical procedures with the help of an oral surgeon. Especially, transverse deficiency of the mandible can be corrected by widening the transverse width of mandibular symphysis, using distraction osteogenesis. Transverse widening of mandibular sympysis is known as a safe treatment but still complications could occur during the treatment. We are reporting some complications of cases that mandibular symphysis transverse widening were applied. Some cases showed complications because of the inappropriate osteotomy line. Since straight vertical osteotomy line was inclined to the left, only the left bony segment was likely to expand. According to bio-mechanical considerations, it will be better to perform a step osteotomy, cutting the eccentric area of the alveolar crest and the centric area of the basal symphyseal area. Complications could also occur by the failure of the distraction device. The tooth borne distraction device was attached on the lingual side of the tooth with composite resin. During the distraction period, it was impossible to obtain appropriate distraction speed and rhythm because of frequent fall off of the distraction device. Therefore, distraction device should be attached firmly with orthodontic band or bone screw, etc. Tooth mobility increasement could also occur as a complication. 'Walking teeth phenomenon' was observed during the distraction period, showing severe teeth mobility and pain during mastication. These symptoms fade out during the consolidation period. Since the patient could feel insecure and uncomfortable, it should be notified to the patient before the procedure. Finally, alveolar crestal bone loss could occur. Alveolar crestal bone loss occurred because of lack of distraction device firmness and teeth trauma caused by lower lip biting habit. Therefore, adequate firmness of the distraction device and habit control will be needed.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권4호
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• pp.356-364
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• 2006

Transverse mandibular deficiency has a many problem in growing patients. Therefore, Mandible symphysis widening is recommended. A new surgical technique has been developed to widen the mandible. The purpose of this study is to report the effect of mandibluar symphyseal distraction osteogenesis by use of bone-borne type distractor. The surgical procedure was accomplished under general anaesthesia with step-line osteotomy. Bone-borne type distractor was used to generally widen the mandible. The expansion achieved in the mandible was 8.31mm at the device, 6.32mm at the canines, 4.06mm at the first molars. The symphyseal distraction gaps were bridged by new bony regeneration. Mandibular symphseal distraction osteogenesis increased mandibular arch width, stabilized occlusion, and corrected dental crowding.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권5호
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• pp.543-549
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• 2008

Distraction osteogenesis is a commonly used technique for mandibular lengthening, but changes in the temporomandibular joint(TMJ) have not been well documented. The TMJ is one of the most complex joint in the body and is composed of a fibrous surface layer, a proliferative zone, hypertrophic cartilage, and bone. The shape and role of the TMJ change and modify during a person's life-time. Possible complications that can arise after mandibular distraction include failure of the formation, failure of callus, infection, disturbance of TMJ and of occlusion. However, there are only a few reports on changes in the TMJ as a result of distraction osteogenesis. Hence, the goal of this study was to evaluate the change of the TMJ after experimental distraction of mandibular ramus in rabbit. We studied histological changes of mandibular condyle, articular disk and retrodiscal tissue, and also examined the collagen I gene expression and MMP-1 gene expression. The results were as follows. 1. In the histological staining, experimental condylar surface showed more thick fibrous articular layer and proliferative layer, compared with the control condyle and experimental articular disc showed thick and dense collagen fibers compared with the control disc. 2. In the collagen I and MMP-1 gene RT-PCR analysis, experimental discs showed increased collagen I expression compared with the control disc, while MMP-1 gene expression was decreased compared with the control disc. The retrodiscal tissue was almost equal expressions of the collagen I and MMP-1 genes compared with the control retrodiscal tissue. These findings suggest that histological and biomolecular changes occur in condyles and discs after unilateral mandibular distraction osteogenesis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권6호
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• pp.444-449
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• 2003

Distraction osteogenesis is a biologic process in which new bone is formed between bone fragments being separated by a tractional force. This technique has the advantage of initiating new bone growth without bone transplantation and promoting the growth of soft tissue. Mandibular distraction osteogenesis has shown to be effective to treat congenital or acquired mandibular hypoplasias. On the basis of positive results with implant-supported prostheses, the use of implants in the distracted site can significantly help stabilize the prosthesis. We obtained good result in the patient with mandibular deficiency due to trauma, who have been reconstructed with distraction osteogenesis and implant. We report our experiences with literature view.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권6호
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• pp.526-531
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• 2005

Distraction osteogenesis is a technique of bone lengthening by gradual movement and subsequent remodeling. Distraction forces applied to bone also create tension in the surrounding soft tissues, distraction histiogenesis. Distraction osteogenesis is used to correct facial asymmetry, such as patients with hemifacial microsomia, maxillary or mandibular retrusion, cleft lip & palate, alveolar defect and craniofacial deficiency. Hemifacial microsomia is characterized by unilateral facial hypoplasia, often with unilateral shortening of the mandible and subsequent malocclusion. This report describes two cases of hemifacial microsomia(type IIB). In these two cases, distraction osteogenesis was used to correct a facial asymmetry. Two patients underwent unilateral mandibular distraction osteogenesis of ascending ramus of the mandible with extraoral devices. Successful distraction osteogenesis was achieved in the patients with hemifacial microsomia.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권3호
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• pp.217-226
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• 2007

Purpose: Distraction osteogenesis is considered to take favorable effect on the TMJ and be beneficial to prevent the relapse after the mandibular advancement of Class II malocclusion patient. This is the report with literature review on the mandibular advancement in the patients showing preoperative condylar resorption and who need larger amount of advancement. Patients and method: Distraction osteogenesis using intraoral device was performed for three mandibular hypoplasia patients (one male and two females). All patients were adult over 18 years old. The patients showed condylar bony resorption preoperatively. The distraction was performed intraorally with modified SSRO. After 7 days of latency period, activation was performed at the rate of 1.0 mm/day with twice turn. The devices were removed after 4-8 month consolidation period. Results: Total advancement of mandible was average 13 mm. One patient showed openbite immediately after removal of distraction device. It took long time to guide the openbite with elastics. The comparison between cephalometries immediately after device removal and postoperative six month revealed average 3.4 mm relapse. This means that mandibular advancement with distraction osteogenesis needs overcorrection and elastic rehabilitation even after enough consolidation periods. Conclusion: Larger amount of mandibular advancement could be achieved with distraction osteogenesis in severe mandibular hypoplasia with condylar resorption. However, some relapse was found during the follow-up period and the over correction is considered to be needed. The effect of distraction osteogenesis seems to be investigated with long-term follow-up.